Elderly persons who have suffered a disabling medical event, such as a hip fracture, are likely to develop depression. Late-life depression (LLD) adversely affects acute medical rehabilitation, increasing the risk for persistent depression and disability. Existing acute medical rehabilitation settings ? skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs) ? do not adequately meet the needs of depressed elders, resulting in a missed opportunity for affective and functional recovery. This R34 will develop enhanced medical rehabilitation for depressed older adults who are admitted to a SNF after a disabling medical event. The goal of this enhanced rehabilitative care is to reduce depressive symptoms and improve function. The intervention will consist of (1) high intensity PT &OT, and (2) comprehensive team-based management that incorporates mental health expertise. In this R34 we will develop enhanced medical rehabilitation in three stages: (1) develop a treatment manual;(2) pilot and iteratively modify the intervention;(3) carry out a preliminary randomized trial of the intervention in a SNF, with usual care comparison. The R34 is led by a multidisciplinary team with expertise in rehabilitation research and in mental health interventions in medical settings PUBLIC HEALTH RELEVANCE: Disabling medical events (such as hip fracture) occur approximately 6 million times per year in elderly persons in the US. There is a high incidence of late-life depression (LLD) in this context, which interferes with recovery from the medical event and increases functional dependence, institutionalization, and mortality. If successful, this proposal will have a significant public health impact, in that it will develop an effective nonpharmacological treatment for LLD that is applicable to the acute medical rehabilitation setting.